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Biomedical subjects

L G Keith

Publications and source records attributed to L G Keith.

At least 37 records · Page 2Linked to original sources
PubMed1995

Asymptomatic endometrial carcinoma after endometrial ablation.

Endometrial ablation has been recently introduced as a surgical alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. The procedure itself is reasonably safe. However, if occult endometrial cancer is present before the procedure and is not detected, it may be more difficult to diagnose later. Endometrial cancer may also arise de novo from missed endometrial tissue. Two cases of endometrial cancer following endometrial ablation have been reported, but its overall incidence is unknown. A 58-year-old woman was treated with endometrial ablation for dysfunctional uterine bleeding. Three years later she underwent hysterectomy and Marshall-Marchetti-Krantz procedure for urinary incontinence; incidental, asymptomatic endometrial adenocarcinoma was discovered. The final pathology was grade 1 adenocarcinoma, invading more than 50% of the myometrium (FIGO stage Ic). Endometrial cancer may occur following endometrial ablation and it may be asymptomatic. Careful patient selection and close follow-up are essential.

Adenocarcinoma↗
PubMed1995

The regionalization of perinatal care in France--description of a missing policy.

This paper reviews published data on the organization and evaluation of regionalized perinatal care programs in countries where they exist and describes those elements presently lacking in France. The advantage of maternal compared to neonatal transport is described vis-85-vis its effect on perinatal deaths as well as neonatal and developmental handicaps. Most studies describe a major advantage of maternal transfers, with less perinatal deaths (including stillbirths and neonatal deaths) and lower rates of severe developmental handicaps. In contrast, French publications show that widespread regionalization of perinatal care does not exist in spite of proposals advocating this concept made more than 20 years ago. Thus, many deliveries of less than 33 weeks gestation length or/and less than 1500 g birth weight take place in maternity sites without adequate neonatal care, despite ample evidence that such infants are at much greater risk of perinatal death or severe handicaps at 2 years of age after transfer than if they had been born in a perinatal center. For these reasons, professional organizations in France should choose to implement a policy of maternal transfers as a major effort in the near future.

Birth Weight↗
PubMed1993

The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation.

OBJECTIVE: Our purpose was to evaluate factors associated with the best intrauterine growth and lowest morbidity among twins ("ideal twin pregnancy"). STUDY DESIGN: A historic prospective study of 163 twin births was performed. Ten models were formulated with multiple regression and multivariate logistic regression. RESULTS: In the models of birth weight, gestations of 28 to 36 and 39 to 41 weeks, black race, > or = 15% discordancy, and smoking were all significant negative factors. The pattern of early low weight gain (< 0.85 pounds per week before 24 weeks) and late low weight gain (< 1.0 pound per week after 24 weeks) was negatively associated with all eight models of intrauterine growth. CONCLUSIONS: The best intrauterine growth and lowest morbidity is achieved earlier for twins than for singletons. Using length of stay and growth retardation criteria, nearly 70% of "ideal" twin pregnancies were between 35 and 38 weeks. In addition, poor weight gain and poor patterns of weight gain were associated with all measures of intrauterine growth and adverse pregnancy outcomes.

Baltimore↗
PubMed1992

The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States.

Among multiple gestations the magnitude of neonatal mortality, morbidity and postneonatal handicap is unknown. Although the proportion of multiple births has risen dramatically during the past decade, the proportion of total births in the United States is relatively small. The vast majority of multiples are low birth weight (LBW) or very low birth weight (VLBW), conditions that magnify both short-term and long-term risks. In this study, the risks for infant mortality and for postneonatal morbidity and handicap have been calculated from race-, plurality- and birth weight-specific mortality rates from the National Infant Mortality Surveillance (NIMS) Project and birth weight-specific postneonatal handicap rates from the Office of Technology Assessment report Healthy Children in proportion to the 1988 U.S. birth cohort. U.S. health objectives for the year 2000 for race-specific birth weight and infant mortality rates were used for comparison. Compared with that of singletons, twins' and triplets' relative risks for LBW are 10.3 and 18.8, respectively. Their relative risks for VLBW are 9.6 and 32.7. Compared with singletons, twins and triplets have relative risks for infant mortality of 6.6 and 19.4, respectively. For twins and triplets, postneonatal survivors' relative risks for severe handicap are 1.7 and 2.9 while those for overall handicap are 1.4 and 2.0, respectively. Recommendations for optimizing pregnancy outcomes in multiple gestations include liberalized weight gains, reduced physical effort and early, comprehensive prenatal care.

Persons with Disabilities↗
PubMed1992

Calcium requirements and the diets of women and children. A review of dairy resources.

This review concerns the role of calcium in nutrition and health and its relation to the changing American diet. The ideal dietary calcium intakes for women and children represent the United States Department of Agriculture's most recent recommended dietary allowances. Both calcium and total nutrient composition of cow, goat and human milk differ. Goat milk has special utility in the treatment of childhood allergy.

Adult↗
PubMed1991

Doppler umbilical velocimetry in women with polydrug abuse including cocaine.

Doppler umbilical artery velocimetry was performed in 40 chemically dependent women. The mean S/D ratio was 2.7 with 15/66 values greater than or equal to 3.0. No cases of absent or reverse end-diastolic flow were noted. The mean S/D ratio in women with positive toxicologies for cocaine use was not statistically elevated compared to women with negative screens (2.8 versus 2.7, P = 0.51). In this study an S/D ratio greater than or equal to 3.0 had a sensitivity of 40% for identifying intrauterine growth retardation with a positive predictive value of 20%.

Adult↗
PubMed1991

The costs of multiple pregnancy.

This paper reviews US vital statistics to describe the increase in multiple births in the United States between 1977 and 1987 and clarify the participation of differing maternal ethnic and age groups to this trend. The projected needs for NICU beds and costs of handicaps are estimated based on the distribution of low birthweights in multiple gestations. The potential methods of changing the distribution of low birthweight infants in multiple pregnancies are discussed.

Costs and Cost Analysis↗
PubMed1991

Northwestern University Twin Study X: Outcome of twin gestations complicated by gestational diabetes mellitus.

Existing data concerning the effect of gestational diabetes on perinatal outcome in twin pregnancies is scant. We hypothesized that altered carbohydrate metabolism would worsen perinatal outcome in twin gestation in a manner similar to singleton gestation. Thirteen twin pregnancies complicated by gestational diabetes mellitus were matched by gestational age at delivery to 13 twin pregnancies unaffected by gestational diabetes. Comparing infants of diabetic mothers to infants of control mothers, there was a trend of greater likelihood of respiratory distress syndrome, hyperbilirubinemia, and prolonged neonatal intensive care nursery admissions. Our experience suggests that altered carbohydrate metabolism in multiple gestations increases the potential for neonatal morbidity.

Adult↗
PubMed1990

The prevalence of substance abuse in patients with suspected preterm labor.

Premature labor is a recognized complication of substance abuse in pregnancy. However, the prevalence of substance abuse in patients first seen with symptoms of preterm labor and who deny use of illicit drugs is unknown. Between July 1, 1988, and December 15, 1988, 141 patients first seen at Northwestern Memorial Hospital in suspected preterm labor and a comparison group of 108 uncomplicated laboring term patients had urine toxicology screening performed to detect substance abuse. Positive urine toxicology screenings were found in 24 of 141 (17.0%) patients with suspected preterm labor and in 3 of 108 (2.8%) patients in the comparison group. The most common substance identified was cocaine (14/24 and 1/3, respectively). Of those patients in suspected preterm labor, 22 of 86 (25.6%) clinic patients had positive urine toxicology screenings as did 2 of 55 (3.6%) private patients. On the basis of our observations, we recommend that patients admitted in possible preterm labor be encouraged to submit to screening for substance abuse so that appropriate counseling and prenatal and neonatal care become available for these high-risk patients.

Adolescent↗
PubMed1990

Multiple pregnancy: an international perspective.

This article discusses the following areas of interest related to the obstetric care of multiple pregnancy: 1) methods of diagnosis and ultrasound, 2) pregnancy protection through adequate maternal nutrition, 3) mode of delivery, 4) discordant twins, and 5) assisted reproductive technology. The article also emphasizes the FIGO/WHO concerns regarding safe motherhood and proposes a four point program to reduce perinatal death rates in multiple pregnancy. These elements are: 1) adequate primary health care including access to family planning information and technology, 2) prenatal care with referral of high risk patients to specialized centers, 3) the presence of trained personnel for all women in childbirth, 4) effective access to obstetric care for women who are pregnant, giving birth, or recently delivered.

Female↗
PubMed1990

The cost effectiveness of preventing preterm delivery in twin pregnancies.

As an extension of previous work on the risk of prematurity in singletons and on the social cost of twin births, an analysis has been carried out into the cost effectiveness of preventing premature delivery in twin pregnancies. The cost of prevention is assessed in terms of early diagnosis through ultrasound screening and of an extra 11 weeks of work leave to expectant mothers. When this cost is compared to the social cost involved in the transfer of newborns to neonatal intensity care units and in supporting handicapped children, it is concluded that the total cost of prevention corresponds to one-third of the long-term costs associated to lack of prevention.

Cost-Benefit Analysis↗
PubMed1990

The Northwestern University Twin Study. XV: Rationales for a standard of care in compromised twin pregnancies.

Current antenatal technologies have improved the obstetrician's ability to assess fetal well-being as well as to diagnose fetal compromise. These technologies have given rise to very difficult ethical issues in the management of compromised twin pregnancies: for example, a choice must be made between putting a healthy twin at risk due to preterm delivery for the sake of a compromised cotwin or of allowing the compromised twin to die in order to buy time for the healthy twin. Though each case is unique, good medical practice requires a standard of care by which consistent patient management can be proposed. In the pluralistic environment of Northwestern Memorial Hospital, our staff has favored a standard of care based on patient autonomy. This approach demands: 1) a practitioner who offers a thorough explanation of the diagnosis and possible treatment approaches; 2) time for the patient and her partner to assimilate this information and test treatment options against their personal value system; 3) a third, but disinterested, party to facilitate patient understanding and value clarification; 4) a practitioner either willing to support the patient's decisions or refer her to another practitioner who will.

Diseases in Twins↗
PubMed1990

Monozygotic twinning as a congenital defect and congenital defects in monozygotic twins.

The process of monozygotic twinning in animals and humans is presented. In addition, congenital defects in monozygotic twins versus dizygotic twins and singletons is discussed. Overall, the rates of congenital anomalies are higher among whites as compared to blacks, males as compared to females, and multiples as compared to singletons. The highest rates are among infants born to women in the oldest age category and infants with birth weights below 2,000 g. Among white infants, live births in plural deliveries had 22% more congenital anomalies as compared to single live births. Among black infants, the rate was only 4% higher among multiples. It has been suggested that the more frequent occurrence of low birth weight and preterm delivery among multiple births and by race are critical to the higher incidence of congenital anomalies in twins. Newer theories relating the twinning process to congenital anomalies in twins are also presented.

Adolescent↗
PubMed1990

The challenge of maternal phenylketonuria screening and treatment.

All newborn infants, male and female, have been screened for phenylketonuria (PKU) since 1961. Medical therapy is generally continued until age 6. The first cohort of treated females reached reproductive age 15 years ago, and new members are joining this cohort annually. This paper reviews the implications of childbearing in women who were treated for PKU as children and are no longer under treatment. Untreated maternal PKU can lead to mental retardation in utero.

Adolescent↗
PubMed1989

The Yoruba contribution to our understanding of the twinning process.

The Yoruba people of Nigeria possess a twinning rate more than fourfold that of Caucasian populations. As such, they provide extraordinary possibilities for the study of multiple birth. Percy Nylander clarified many of the factors that contribute to this high incidence of twinning. His analyses of Nigerian placentation and zygosity have shown the increased rate of multiple pregnancy to be a result of higher proportions of dizygotic twins and trizygotic triplets as compared to Caucasian populations. Whereas a well-established genetic influence upon dizygotic twinning exists throughout the rest of the world, there may be an environmental factor in Nigeria responsible for the increased incidence of multiple births. Nylander's study of the Yoruba also has provided important contributions to the studies of perinatal mortality in multiple gestation. In totality, much of Nylander's work can be applied to further the understanding of ethnic and racial differences in human twin placentation and zygosity.

Birth Rate↗
PubMed1989

Cocaine abuse during pregnancy: correlation between prenatal care and perinatal outcome.

Cocaine abuse during pregnancy has been associated with increased perinatal morbidity and mortality regardless of the quantity or quality of prenatal care. In this study, we tested the hypothesis that among cocaine-abusing women delivering at the same institution, those receiving comprehensive prenatal care have better perinatal outcome than those receiving little or no prenatal care. Between January 1, 1984 and July 1, 1987, 120 pregnant women who abused cocaine received multidisciplinary prenatal care in the Perinatal Center for Chemical Dependence of Northwestern University (group 1). During this same period, we identified 21 cocaine-abusing parturients at our institution who were not enrolled in the Perinatal Center for Chemical Dependence and who received little or no prenatal care (group 2). Control subjects were selected from the general obstetric population for comparison. Data from these two groups were compared with each other and with matched control pregnancies. Group 2 pregnancies had lower mean gestational age at delivery, lower mean birth weight, and a higher incidence of preterm delivery than group 1 pregnancies. Furthermore, groups 1 and 2 were significantly different from control pregnancies for these parameters. We conclude that comprehensive prenatal care may improve outcome in pregnancies complicated by cocaine abuse; however, the perinatal morbidity associated with cocaine abuse cannot be eliminated solely by improved prenatal care.

Adult↗